Postpartum haemorrhage and emergencies: nitroglycerin in retained placenta: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Postpartum haemorrhage and emergencies: nitroglycerin in retained placenta

Sample item

Thirty minutes after delivery the placenta is retained, with no active bleeding, and a constriction ring is felt at the cervix. Before manual removal in theatre, which drug can help?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Nitroglycerin, to relax the uterus

A contraction ring can trap a placenta that has separated or can hinder entry of the hand. Nitroglycerin relaxes the uterus and cervix for a short time and allows manual removal, which is followed by uterotonics to contract the uterus.

Option by option

  • A. Nitroglycerin, to relax the uterus (correct)

    Correct. Brief uterine relaxation lets the hand enter and the placenta come out.

  • B. Intramyometrial carboprost

    Carboprost would increase contraction and tighten the ring.

  • C. Intravenous methylergometrine

    Ergometrine causes tonic contraction and would trap the placenta further.

  • D. Oxytocin bolus into the cord

    Oxytocin injection into the cord is not a reliable remedy for a constriction ring.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Nitroglycerin, to relax the uterus. A contraction ring can trap a placenta that has separated or can hinder entry of the hand.

Why is "Intramyometrial carboprost" not the answer?

Carboprost would increase contraction and tighten the ring.

Why is "Intravenous methylergometrine" not the answer?

Ergometrine causes tonic contraction and would trap the placenta further.

Why is "Oxytocin bolus into the cord" not the answer?

Oxytocin injection into the cord is not a reliable remedy for a constriction ring.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: nitroglycerin in retained placenta in OBG. Nitroglycerin relaxes the uterus and cervix for a short time and allows manual removal, which is followed by uterotonics to contract the uterus.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Postpartum haemorrhage and emergencies: nitroglycerin in retained placenta?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.